Impact of direct oral anticoagulant use on mortality in very old patients with non-valvular atrial fibrillation
Impact of direct oral anticoagulant use on mortality in very old patients with non-valvular atrial fibrillation
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DOI：
10.1093/ageing/afac146
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发表时间：
2022-07-01
期刊：
影响因子：
6.7
通讯作者：
Ito, Hiroshi
中科院分区：
文献类型：
--
作者：
Takahashi, Masahiko;Okawa, Keisuke;Ito, Hiroshi
背景直接口服抗凝剂（DOAC）与华法林相比，在高龄非瓣膜性房颤（NVAF）患者中的有效性和安全性在血栓栓塞和出血方面已有报道。然而，DOAC的使用与此类患者死亡率的关系仍不清楚。目的：本研究旨在研究高龄NVAF患者使用DOAC与华法林相比的死亡率、血栓栓塞和大出血发生率。方法：我们对年龄≥ 80岁、使用口服抗凝剂的NVAF连续患者进行了一项单中心历史队列研究。我们比较了DOAC组和Warfare组的5年结局（全因死亡率、血栓栓塞、大出血和颅内出血）。结果在1，676例年龄在80岁及以上的房颤患者中，包括1，208例NVAF。倾向评分匹配提供了每组461名患者，DOAC组的全因死亡、血栓栓塞、大出血和颅内出血的风险显着低于华法林组（DOAC使用的风险比[95%置信区间]，0.68 [0.54-0.87]，0.31 [0.19-0.53]，0.56 [0.36-0.88]，0.23 [0.10-0.56]，对数秩P = 0.002，P < 0.001，P = 0.010，P < 0.001）。大出血后1年内死亡率DOAC组显著低于Warfare组（14% vs 38%，P = 0.03），但血栓栓塞后两组相似（33% vs 35%）。结论年龄≥ 80岁的NVAF患者使用DOAC的死亡率低于使用华法林的患者。
Background the efficacy and safety of direct oral anticoagulants (DOACs) compared with that of warfarin in very old patients with non-valvular atrial fibrillation (NVAF) have been reported in terms of thromboembolisms and bleeding. However, the association of DOAC use and mortality in such patients remains unclear. Objectives this study aimed to investigate the incidence of mortality, as well as thromboembolisms and major bleeding, in very old patients with NVAF using DOACs as compared with warfarin. Methods we conducted a single-centre historical cohort study of consecutive patients with NVAF aged >= 80 years who used oral anticoagulants. We compared the 5-year outcomes (all-cause mortality, thromboembolism, major bleeding and intracranial haemorrhage) between the DOAC and Warfarin groups. Results of 1,676 patients with atrial fibrillation aged 80 years and over, 1,208 with NVAF were included. Propensity score matching provided 461 patients in each group, and the risk of all-cause mortality, thromboembolisms, major bleeding and intracranial haemorrhages was significantly lower in the DOAC group than Warfarin group (hazard ratio [95% confidence interval] for DOAC use, 0.68 [0.54-0.87], 0.31 [0.19-0.53], 0.56 [0.36-0.88], 0.23 [0.10-0.56], log-rank P = 0.002, P < 0.001, P = 0.010, P < 0.001). The mortality rate within 1 year after major bleeding was significantly lower in the DOAC group than Warfarin group (14% versus 38%, P = 0.03), however, that after a thromboembolism was similar between the two groups (33% versus 35%). Conclusion patients with NVAF aged >= 80 years and using DOACs had a lower mortality than those using warfarin.